| NPI | 1639599897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857100) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60915) |
| 122300000X Dentist (Licence: CT 03679680) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2015-12-29 |